The NIHR collaboration for leadership in applied health research and care (CLAHRC) for Greater Manchester: combining empirical, theoretical and experiential evidence to design and evaluate a large-scale implementation strategy
Implementation Science - 2011
Tóm tắt
In response to policy recommendations, nine National Institute for Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care (CLAHRCs) were established in England in 2008, aiming to create closer working between the health service and higher education and narrow the gap between research and its implementation in practice. The Greater Manchester (GM) CLAHRC is a partnership between the University of Manchester and twenty National Health Service (NHS) trusts, with a five-year mission to improve healthcare and reduce health inequalities for people with cardiovascular conditions. This paper outlines the GM CLAHRC approach to designing and evaluating a large-scale, evidence- and theory-informed, context-sensitive implementation programme. The paper makes a case for embedding evaluation within the design of the implementation strategy. Empirical, theoretical, and experiential evidence relating to implementation science and methods has been synthesised to formulate eight core principles of the GM CLAHRC implementation strategy, recognising the multi-faceted nature of evidence, the complexity of the implementation process, and the corresponding need to apply approaches that are situationally relevant, responsive, flexible, and collaborative. In turn, these core principles inform the selection of four interrelated building blocks upon which the GM CLAHRC approach to implementation is founded. These determine the organizational processes, structures, and roles utilised by specific GM CLAHRC implementation projects, as well as the approach to researching implementation, and comprise: the Promoting Action on Research Implementation in Health Services (PARIHS) framework; a modified version of the Model for Improvement; multiprofessional teams with designated roles to lead, facilitate, and support the implementation process; and embedded evaluation and learning. Designing and evaluating a large-scale implementation strategy that can cope with and respond to the local complexities of implementing research evidence into practice is itself complex and challenging. We present an argument for adopting an integrative, co-production approach to planning and evaluating the implementation of research into practice, drawing on an eclectic range of evidence sources.
Từ khóa
Tài liệu tham khảo
Schuster M, McGlynn E, Brook RH: How good is the quality of health care in the United States?. The Milbank Quarterly. 1998, 76: 517-563. 10.1111/1468-0009.00105.
Grol R: Successes and failures in the implementation of evidence-based guidelines for clinical practice. Medical Care. 2001, 39 (8 Supp 2): 1146-1154.
Cooksey D: A review of UK health research funding: Sir David Cooksey. 2006, London, The Stationery Office
Department of Health: Report of the High Level Group on Clinical Effectiveness chaired by Professor Sir John Tooke. 2007, London, Department of Health
Baker R, Robertson N, Rogers S, Davies M, Brunskill N, Khunti K, Steiner M, Williams M, Sinfield P: The National Institute of Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Leicestershire, Northamptonshire and Rutland (LNR): a programme protocol. Implementation Science. 2009, 4: 72-10.1186/1748-5908-4-72.
Hanbury A, Thompson C, Wilson PM, Farley K, Chambers D, Warren E, Bibby J, Mannion R, Watt IS, Gilbody S: Translating research into practice in Leeds and Bradford (TRiPLaB): a protocol for a programme of research. Implementation Science. 2010, 5: 37-
Bero LA, Grilli R, Grimshaw JM, Harvey E, Oxman AD, Thomson MA: Closing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findings. BMJ. 1998, 317: 465-468.
Dopson S, Fitzgerald L, eds: Knowledge to Action? Evidence-based health care in context. 2005, Oxford: Oxford University Press
Grol R, Grimshaw J: From best evidence to best practice: effective implementation of change in patients' care. The Lancet. 2003, 362: 1225-1230. 10.1016/S0140-6736(03)14546-1.
Glasby J, Walshe K, Harvey G: Making evidence fit for purpose in decision making: a case study of the hospital discharge of older people. Evidence and Policy. 2007, 3 (3): 425-437. 10.1332/174426407781738065.
Eccles M, Grimshaw J, Walker A, Johnston M, Pitts N: Changing the behaviour of healthcare professionals: the use of theory in promoting the uptake of research findings. Journal of Clinical Epidemiology. 2005, 58: 107-112. 10.1016/j.jclinepi.2004.09.002.
Grol R, Bosch M, Hulscher M, Eccles M, Wensing M: Planning and studying improvement in patient care: The use of theoretical perspectives. The Milbank Quarterly. 2007, 85 (1): 93-138. 10.1111/j.1468-0009.2007.00478.x.
Davies P, Walker AE, Grimshaw JM: A systematic review of the use of theory in the design of guideline dissemination and implementation strategies and interpretation of the results of rigorous evaluations. Implementation Science. 2010, 5: 14-10.1186/1748-5908-5-14.
Kolb DA: Experiential learning: experience as the source of learning and development. 1984, London: Prentice-Hall
Dopson S, FitzGerald L, Ferlie E, Gabbay J: No Magic Targets! Changing Clinical Practice to Become More Evidence based. Health Care Management Review. 2002, 27 (3): 35-47.
Ferlie E, Fitzgerald L, Wood M: Getting evidence into clinical practice: An organizational behavior perspective. Journal of Health Services Research and Policy. 2000, 5 (1): 1-7.
Thompson C, McCaughan D, Cullum N, Sheldon TA, Mulhall A, Thompson DR: Research information in nurses' clinical decision making: what is useful?. Journal of Advanced Nursing. 2001, 36 (3): 376-388. 10.1046/j.1365-2648.2001.01985.x.
Rycroft-Malone J, Seers K, Titchen A, Harvey G, Kitson A, McCormack B: What counts as evidence in evidence-based practice?. Journal of Advanced Nursing. 2004, 47 (1): 81-90. 10.1111/j.1365-2648.2004.03068.x.
Nutley SM, Walter I, Davies HTO: Using Evidence: How research can inform public services. 2007, Bristol: The Policy Press
Kitson A, Harvey G, McCormack B: Enabling the implementation of evidence based practice: a conceptual framework. Quality in Health Care. 1998, 7 (3): 149-159. 10.1136/qshc.7.3.149.
Bucknall T: The clinical landscape of critical care: nurses' decision making. Journal of Advanced Nursing. 2003, 43 (3): 310-319. 10.1046/j.1365-2648.2003.02714.x.
Ferlie E, Wood M, Fitzgerald L: Some limits to evidence based medicine: a case study from elective orthopaedics. Quality in Health Care. 1999, 8: 99-107. 10.1136/qshc.8.2.99.
Haines A, Jones R: Implementing findings of research. British Medical Journal. 1994, 308: 1488-1492.
Landry R, Amara N, Lamari M: Utilization of social science research knowledge in Canada. Research Policy. 2001, 30: 333-349. 10.1016/S0048-7333(00)00081-0.
Rycroft-Malone J, Kitson A, Harvey G, McCormack B, Seers K, Titchen A, Estabrooks C: Ingredients for Change: Revisiting a conceptual model. Quality and Safety in Health Care. 2002, 11: 174-180. 10.1136/qhc.11.2.174.
Ferlie E, Fitzgerald L, Wood M, Hawkins C: The (Non) Diffusion of Innovations: The Mediating Role of Professional Groups. Academy Management Journal. 2005, 48 (1): 117-34.
Graham ID, Logan J, Harrison MB, Straus SE, Tetroe J, Caswell W, Robinson N: Lost in knowledge translation: Time for a map?. The Journal of Continuing Education in the Health Professionals. 2006, 26: 13-24. 10.1002/chp.47.
Kitson A, Rycroft-Malone J, Harvey G, McCormack B, Seers K, Titchen A: Evaluating the successful implementation of evidence into practice using the PARIHS framework: theoretical and practical challenges. Implementation Science. 2008, 3: 1-10.1186/1748-5908-3-1.
Ward V, Smith S, Carruthers S, Hamer S, House A: Knowledge Brokering: Exploring the process of transferring knowledge into action. 2010, University of Leeds: Leeds Institute of Health Sciences
Ferlie E, Dopson S, Fitzgerald L, Locock L: Renewing policy to support evidence-based health care. Public Administration. 2009, 87 (4): 837-852. 10.1111/j.1467-9299.2009.01796.x.
McCormack B, Kitson A, Harvey G, Rycroft-Malone J, Titchen A, Seers K: Getting evidence into practice: the meaning of context. Journal of Advanced Nursing. 2002, 38 (1): 94-104. 10.1046/j.1365-2648.2002.02150.x.
Denis J-L, Lehoux P: Organizational theory. Knowledge Translation in Health Care. Edited by: Strauss S, Tetroe J, Graham ID. 2009, London: Wiley-Blackwell & BMJ Books, 215-225.
Lave J, Wenger E: Situated Learning: Legitimate Peripheral Participation. 1991, Cambridge: Cambridge University Press
Wenger E: Communities of Practice: Learning, Meaning and Identity. 1998, Cambridge: Cambridge University Press
Wenger E: Communities of practice and social learning systems. Organization. 2000, 7: 225-246. 10.1177/135050840072002.
Oborn E, Barrett M, Racko G: Knowledge translation in healthcare: A review of the literature. 2010, Working Paper Series 5/2010. University of Cambridge: Cambridge Judge Business School
Soumerai SB, Avorn J: Principles of educational outreach ('academic detailing') to improve clinical decision making. JAMA. 1990, 263 (4): 549-556. 10.1001/jama.263.4.549.
Stetler CB, Legro MW, Rycroft-Malone J, Bowman C, Curran G, Guihan M, Hagedorn H, Pineros S, Wallace CM: Role of 'external facilitation' in implementation of research findings: a qualitative evaluation of facilitation experiences in the Veterans Health Administration. Implementation Science. 2006, 1: 23-10.1186/1748-5908-1-23.
Zwarenstein M, Bheekie A, Lombard C, Swingler G, Ehrlich R, Eccles M, Sladden M, Pather S, Grimshaw J, Oxman AD: Educational outreach to general practitioners reduces children's asthma symptoms: a cluster randomized controlled trial. Implementation Science. 2007, 2: 30-10.1186/1748-5908-2-30.
Stetler CB, McQueen L, Demakis J, Mittman BS: An organizational framework and strategic implementation for system-level change to enhance research-based practice: QUERI series. Implementation Science. 2008, 3: 30-10.1186/1748-5908-3-30.
Dobbins M, Hanna SE, Ciliska D, Manske S, Cameron R, Mercer SL, O'Mara L, DeCorby K, Robeson P: A randomized controlled trial evaluating the impact of knowledge translation and exchange strategies. Implementation Science. 2009, 4: 61-10.1186/1748-5908-4-61.
Harvey G, Loftus-Hills A, Rycroft-Malone J, Titchen A, Kitson A, McCormack B, Seers K: Getting evidence into practice: the role and function of facilitation. Journal of Advanced Nursing. 2002, 37 (6): 577-588. 10.1046/j.1365-2648.2002.02126.x.
Nowotny H, Scott P, Gibbons M: Re-thinking science. Knowledge and the public in an age of uncertainty. 1997, Cambridge: Polity Press
Bowen S, Martens P, The Need to Know Team: Demystifying knowledge translation: learning from the community. Journal of Health Services Research & Policy. 2005, 10 (4): 203-211. 10.1258/135581905774414213.
Doran DM, Sidani S: Outcomes-focused knowledge translation: A framework for Knowledge translation and patient outcomes improvement. Worldviews on Evidence-Based Nursing. 2007, 4 (1): 3-13. 10.1111/j.1741-6787.2007.00073.x.
Wallin L, Estabrooks CA, Midodzi WK, Cummings GG: Development and validation of a derived measure of research utilization by nurses. Nursing Research. 2006, 55 (3): 149-160. 10.1097/00006199-200605000-00001.
Walsh K, Lawless J, Moss C, Allbon C: The development of an engagement tool for practice development. Practice Development in Health Care. 2005, 4 (3): 124-130. 10.1002/pdh.7.
Helfrich CD, Damschroder LJ, Hagedorn HJ, Daggett GS, Sahay A, Ritchie M, Damush T, Guihan M, Ullrich PM, Stetler CB: A critical synthesis of literature on the promoting action on research implementation in health services (PARIHS) framework. Implementation Science. 2010, 5: 82-10.1186/1748-5908-5-82.
Langley GJ, Nolan KM, Norman CL, Provost LP, Nolan TW: The Improvement Guide. 1996, San Francisco: Jossey-Bass
Boaden R, Harvey G, Moxham C, Proudlove N: Quality Improvement: Theory and Practice in Health Care. 2008, University of Warwick: NHS Institute for Innovation and Improvement
Schouten LM, Hulscher ME, Van Everdingen JJ, Huijsman R, Grol RP: Evidence for the impact of quality improvement collaboratives: Systematic review. BMJ. 2008, 336: 1491-1494. 10.1136/bmj.39570.749884.BE.
accessed 28.2.11, [http://casestudies.ktponline.org.uk/casestudies/results]
Reason P, Heron J: A short guide to cooperative inquiry. [http://www.human-inquiry.com/cishortg.htm]
Harvey G, Wensing M: Methods for the evaluation of small-scale quality improvement projects. Quality and Safety in Health Care. 2003, 12: 210-214. 10.1136/qhc.12.3.210.
Shojania KG, Grimshaw JM: Evidence-based quality improvement: The state of the science. Health Affairs. 2005, 24 (1): 138-150. 10.1377/hlthaff.24.1.138.
Harvey G: Quality improvement and evidence-based practice: As one or at odds in the effort to promote better health care?. Worldviews on Evidence-Based Nursing. 2005, 2 (2): 52-54. 10.1111/j.1741-6787.2005.05001.x.
Department of Health: Equity and Excellence: Liberating the NHS. 2010, London: The Stationery Office